RebelEM

MAY 18, 2023

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Incidence, treatment and outcome of peripartum sepsis. Am J Clin Pathol. 1999 Aug;112(2):211-5.

OB/GYN 91

OB/GYN EMS Sepsis Fluid Resuscitation 91

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Vital signs include BP 168/89, HR 96, T 98.3,

Stroke 111

Stroke EMS EKG/ECG Radiology 111

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. REBEL EM: Peripheral Vasopressors – Safe or Dangerous?

Administration 137

Administration Sepsis EMS Shock 137

PHEM Cast

APRIL 10, 2016

[link] We hope you enjoyed our sepsis podcast. St Emlyns Induction podcast on Sepsis. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. March 2016.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). That sounds reasonable, so what has changed? 0.41), p < 0.001.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles.

Sepsis 95

Sepsis Shock Resuscitation Fluid Resuscitation 95

Emergency Medicine Cases

MARCH 26, 2019

In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? and many more.

Sepsis 40

Sepsis Shock EMS Resuscitation 40

Critical Care Now

AUGUST 18, 2024

ClinicalTrials.gov: NCT025174897 Background: Community-acquired pneumonia (CAP) can lead to significant pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and increased mortality. The primary outcome showed a 28-day mortality of 6.2% Check out the full post on REBEL EM: [link]

Outcomes 93

Outcomes Sepsis Administration EMS 93

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. appeared first on REBEL EM - Emergency Medicine Blog. to 1.12; p = 0.03

Resuscitation 123

Resuscitation Outcomes EMS Sepsis 123

RebelEM

SEPTEMBER 21, 2023

Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ).

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

JULY 17, 2023

Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4

Outcomes 97

Outcomes Emergency Department Administration Resuscitation 97

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Background There have been a couple of large and influential trials published on BP management after an intracranial hemorrhage (ICH). Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

JUNE 6, 2020

Max is then going to Georgetown to be an attending in both EM and ICU. Background: I think we have covered sepsis more often than any other topic on the SGEM. However, it has become evident that patients are often over-resuscitated with IV fluids which adversely impacts outcome. increase in MAP). Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

OCTOBER 31, 2022

Vitamin C can function as an antioxidant and may mitigate endothelial oxidative stress in sepsis. Amrein 2018) A small, single-center, before-and-after study utilized a sepsis cocktail consisting of IV thiamine, hydrocortisone, and vitamin C and discovered a significant decrease in mortality compared to the control group.

Sepsis 52

Sepsis Outcomes Research Shock 52

EM Curious

JULY 8, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. With a bonus brief on disaster management.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. EM Resident. J Emerg Med.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Taming the SRU

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 97

EKG/ECG Shock Wellness EMS 97

Taming the SRU

JUNE 11, 2023

Methods This was a prospective observational study enrolling all patients who presented to the ED through the lobby and via EMS. Study protocol involved investigators measuring EtCO2 of patients arriving via the lobby or EMS. All nasal cannulas were the same brand, including those in the lobby and used by EMS. West J Emerg Med.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

The Skeptics' Guide to EM

JANUARY 25, 2020

Case: A 60-year-old male is […] The post SGEM#281: EM Docs Got an AmbuBag – The PreVent Trial first appeared on The Skeptics Guide to Emergency Medicine. Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Secondary Outcome: The incidence of severe hypoxemia (oxygen saturation of less than 80%).

EMS 40

EMS Airway Management Administration Resuscitation 40

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Hegeman EM, et al. Schwindt EM, et al. 2023 Apr 18.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

JULY 16, 2022

Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Paul Marik got the critical care world all excited when he claimed a Vitamin C cocktail (Vitamin C, hydrocortisone and thiamine) as a possible cure for sepsis.

Sepsis 40

Sepsis Shock Outcomes EMS 40

RebelEM

OCTOBER 5, 2023

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Secondary Outcome By day 90, mortality was 9.3% 5148 excluded 800 enrolled and randomized in the trial. in the hydrocortisone group vs. 11.9%

Research 94

Research Outcomes Administration Shock 94

The Skeptics' Guide to EM

OCTOBER 3, 2021

Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. In the two large trials, this benefit was seen as a reduction in a composite outcome of major adverse kidney events within 30 days (MAKE-30). Lactated Ringer’s or Plasmalyte 148) over 0.9%

Outcomes 52

Outcomes Sepsis Administration Resuscitation 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Northwestern EM Blog

JANUARY 24, 2022

And for most forms, EM physicians are not typically shocked by shock. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

He writes an excellent blog called EM Nerd , which he describes as nihilistic ramblings. There was also the HYPRESS trial that we reviewed on SGEM#168 with Salim Rezaie from REBEL EM. This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

RebelEM

JANUARY 25, 2023

Small bowel obstruction: Outcome and cost implications of admitting service. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 94.0 – SBO appeared first on REBEL EM - Emergency Medicine Blog. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Emery Med J 2014; 31(3): 248-9.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

All Ohio EM

OCTOBER 26, 2018

In the 25 years since CTPA became readily available to us in the ED, we’ve increased the diagnosis of PE 10-fold without decreasing the number of bad outcomes at all. Corey Slovis would be horrified that I’m not listing 5 things for him, but the one pearl I wanted to emphasize: refractory acidosis in DKA, think abscess, sepsis, or dead gut.

CPR 52

CPR Sepsis Stroke EMS 52

ACEP Now

AUGUST 25, 2023

2 The primary outcome was all-cause mortality at seven days and showed an eight percent absolute increase for patients allocated to the etomidate group. This outcome was no longer statistically different at 28 days. Mortality Outcome: There was a wide range of time points for all-cause mortality (24 hours to 30 days).

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52